Esophageal atresia associated anomalies
Overview
Esophageal atresia (EA) is a fairly common congenital disorder, its incidenceranging between 1/4000 and 1/5000 births. EAresults from the unsuccessfulseparation of the primitive foregut into the ventral respiratory and dorsal di-gestive tracts; this process is usually completed by the eighth week of gesta-tion. Associated congenital anomalies are present in approximately 50% ofinfants with EA 1 2 and seem to be responsible for most of the related mor-bidity and mortality. The recent advances in surgical, anesthesiologic andpreoperative management have remarkably improved the survival rate in theabsence of associated anomalies.
Diagnosis
Diagnosis is suggested by inability to pass an NGT into the stomach. A radiopaque catheter determines the location of the atresia on x-ray. In atypical cases, a small amount of water-soluble contrast material may be needed to define the anatomy under fluoroscopy. The contrast material should be quickly aspirated back because its entrance into the lungs can cause a chemical pneumonitis. This procedure should be done only by a trained radiologist at the center where neonatal surgery will be performed.
Treatment
Preoperative management aims to get the infant into optimal condition for surgery and prevent aspiration pneumonia, which makes surgical correction more hazardous. Oral feedings are withheld. Continuous suction with a double-lumen catheter in the upper esophageal pouch prevents aspiration of swallowed saliva. The infant should be positioned prone with the head elevated 30 to 40° and with the right side down to facilitate gastric emptying and minimize the risk of aspirating gastric acid through the fistula. If definitive repair must be deferred because of extreme prematurity, aspiration pneumonia, or other congenital malformations, gastrostomy is done to decompress the stomach. Suction through the gastrostomy tube then reduces the risk that gastric contents will reflux through the fistula into the tracheobronchial tree.